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AnteayerPLOS ONE Medicine&Health

Preventing burnout: Community health worker perspectives on professional development and emotional labor overload - A qualitative descriptive study

by Meshack Achore, Martine Hackett, Tatiana Ramirez

Introduction

Community health workers (CHWs) play a critical role in advancing health equity by bridging underserved communities with health and social services. However, expanding responsibilities, emotional labor, and fragmented service systems contribute to burnout. While prior research has examined CHW burnout in urban, rural, and crisis contexts, little is known about how burnout is experienced and mitigated in suburban settings characterized by geographic dispersion and administrative fragmentation. This study explored how CHWs in suburban Long Island, New York, experience emotional labor overload and the strategies they use, individually and organizationally, to prevent burnout.

Methods

We conducted a qualitative descriptive study using purposive and snowball sampling and recruited 10 CHWs from Nassau and Suffolk counties in New York. Data were collected through ten semi-structured interviews and five participant observations. Participants were primarily women aged 35–44 years, most of whom (86%) worked in Nassau County and reported 2–5 years of experience. Transcripts were analyzed thematically using Braun and Clarke’s six-step framework in ATLAS.ti.

Results

Two overarching themes emerged: (1) Creating a healthy work-life balance, in which CHWs managed burnout by setting boundaries and practicing self-care; and (2) Building support structures in the workplace, where organizational supports such as supervision, peer collaboration, and ongoing training promoted resilience. Participants emphasized the importance of self-care rituals, spiritual grounding, and collegial networks as protective factors against emotional exhaustion.

Conclusions

Burnout among suburban CHWs is shaped by the interaction of individual coping practices and organizational conditions within fragmented service systems. Strengthening supervision, peer support infrastructure, and professional development opportunities may enhance workforce resilience and sustainability. Investments in organizational support structures are critical to sustaining CHWs’ capacity to promote health equity.

Integrating sequence-based GWAS and comparative genomic analysis reveals conservation and species-specificity of putative functional variants influencing tail length and tail abnormalities in pigs and sheep

by Xuying Zhang, Johanna Mainzer, Isabella Giambra, Tong Yin, Petra Engel, Hannah Hümmelchen, Henrik Wagner, Axel Wehrend, Christiane Egerer, Katharina Gerhards, Gerald Reiner, Sven König

Long tails trigger tail biting in pigs and increase the risk of flystrike infections in sheep. Tail docking has been a common management practice in both species for decades, but increasingly conflicts with legal animal welfare guidelines. Sustainable solutions require breeding strategies targeting shorter tails. In consequence, the aims were to conduct whole-genome sequencing (WGS)-based genome-wide association studies (GWAS) and comparative genomic analyses (CGA) to explore functional elements influencing tail traits. Phenotypically divergent experimental populations of pigs and sheep were established through unified selection and mating experiments. Tail traits included tail length (TL) measured at birth, and tail abnormalities (TA) assessed radiographically at 14 weeks of age. WGS-based GWAS identified a significant locus on SSC18 in pigs and suggestive loci for TL in both species, which, together with previously reported loci for TA, were further analyzed by CGA. The genomic windows of the significant locus on SSC18 in pigs and the TL GWAS locus on OAR4 in sheep were found to be conserved, harboring six common genes with predicted functional variants. These variants were jointly associated with TL (Plm) in both species in linear regression models adjusted for sex, age of the dam, body length, and body weight. In other GWAS locus windows (±1 Mb), species-specific TL candidate genes were identified in sheep (HOXB13, MUC5B, EPB41L3, MTCL1, PIEZO2, MPPE1, and LOXHD1) and in pigs (KNL1, DISP2, SPRED1, TGFB2, and HAND1), each harboring associated putative functional variants. For TA, sheep-specific candidates (PGM2, LRRC66, CRACD, LOC105601916, and SH2D4B) and pig-specific candidates (MYOT, TMCO6, and PCDHAC2) were revealed using logistic regression models (Pglm). GO analyses of candidate genes predicted shared biological processes between sheep and pigs, whereas pathway analyses indicated that common carbohydrate metabolism pathways, along with species-specific immune and inflammatory signaling, and pig-specific TGF-β signaling and endochondral ossification, may contribute to tail length variation and abnormalities. These findings provided deeper insights into the genetic basis of differential embryonic tail morphogenesis and perinatal tail development across species.

Exploring the drivers of price variation in orthopaedic radical bone tumor resection: A nationwide database study

by Devika A. Shenoy, William C. Cruz, Shamik Bhat, Katelyn Parsons, Aaron D. Therien, Kevin A. Wu, Christian A. Pean, William C. Eward

Background

Radical resection of bone tumors is a clinically effective but costly procedure. Despite the implementation of federal price transparency mandates, little is known about the nationwide variation in negotiated prices for these specialized oncologic surgeries. This study aimed to quantify the variation in negotiated rates for radical resection of the humerus and femur/knee and identify associated hospital, payor, and state-policy drivers.

Methods

This cross-sectional study analyzed hospital-negotiated payor rates from the Turquoise Health database for current procedural terminology (CPT) codes 24150 (humerus resection) and 27365 (femur/knee resection). Multivariate linear regression was used to determine the associations between hospital size and type, payor class, and state-level policies (Medicaid expansion, Certificate of Need [CoN] laws, All-Payer Claims Database [APCD] mandates, and Nurse Practitioner [NP] scope of practice) on negotiated payor rates.

Results

A total of 285,857 negotiated rates were analyzed. Significant price variation was observed across all factors. Large hospitals (>1000 beds) and Critical Access Hospitals (for femur/knee resection only) had significantly higher rates. CoN laws were associated with higher prices for both procedures (+$348.25 and +$667.98, respectively), as were APCD mandates for femur/knee resections (+$1231.24). Medicare Advantage plans paid inconsistently compared to commercial plans, paying more for humerus but substantially less for femur/knee resections.

Discussion

Negotiated prices for radical bone tumor resection are highly variable and influenced by a complex interplay of market dynamics, challenging the assumption that price transparency alone can standardize healthcare costs for specialized care.

In-hospital outcomes and associated factors of mortality in thai children with diabetic ketoacidosis: A national data analysis 2015–2023

by Ratikorn Chaisiwamongkol, Rattapon Uppala, Phanthila Sitthikarnkha, Leelawadee Techasatian, Suchaorn Saengnipanthkul, Pope Kosalaraksa, Kaewjai Thepsuthammarat, Sirapoom Niamsanit

Background and aims

Diabetic ketoacidosis (DKA) remains a major cause of pediatric morbidity and death. This study examined national trends in DKA hospitalizations and factors associated with in-hospital mortality among Thai children.

Materials and methods

A nationwide, retrospective cohort study was conducted using data from the National Health Security Office (NHSO) during 2015–2023. Children aged 1 month to under 18 years hospitalized with DKA were identified using International Classification of Diseases, 10th Revision, Thai Modification (ICD-10-TM) codes. Prevalence and mortality were described by year and region. Factors associated with death were assessed with multivariable logistic regression; model discrimination used area under the curve (AUC).

Results

Among 10,669 admissions, national DKA prevalence increased from 4.5 to 11.8 per 10,000 pediatric hospitalizations, with Bangkok showing the highest rates. The overall intubation rate was 10.2%, peaking in infants and older adolescents. Although national mortality declined from 2.2% to 0.6%, regional and age-specific fluctuations persisted. Independent associations with mortality included malignancy (Adjusted odds ratio [AOR] 5.25, 95% CI: 1.63-16.92; p=0.005), septic shock (AOR 2.93, 95% CI: 1.71-5.03; p Conclusion

DKA hospitalizations are increasing in Thailand, with regional variation and persistent mortality risk, particularly among patients with critical complications and vulnerable groups. Although declining mortality trends and lower mortality in recurrent cases suggests improved protocol-based treatment, targeted prevention strategies remain essential for high-risk populations.

The relationship between METS-IR and the risk of diabetes incidence in rural adults in China: A retrospective cohort study based on dynamic population

by Zihao Li, Xuejiao Chen, Wanli Hu, Gefei Li, Xiaoke Zhang, Datian Gao, Haiyun Gao, Songhe Shi

Objective

To evaluate the longitudinal association between the Metabolic Score for Insulin Resistance (METS-IR) and the risk of diabetes mellitus in rural Chinese adults.

Methods

This retrospective cohort study included 53,120 participants aged ≥18 years from 2018 to 2023. Participants were stratified by quartiles of the METS-IR metrics. Cox proportional hazards models assessed the association between METS-IR and incident diabetes. Restricted cubic spline (RCS) models examined nonlinear trends. Subgroup analysis, interaction tests, and multiple sensitivity analyses were performed. Predictive ability was evaluated using time-dependent receiver operating characteristic (ROC) curves.

Results

During 176,413.4 person-years of follow-up (median 3.83 years), 14,397 participants developed diabetes. After multifactorial adjustment, METS-IR was significantly and positively associated with diabetes onset (hazard ratio (HR)=1.094,95% confidence interval (CI): 1.076–1.112, P  Conclusion

METS-IR is significantly correlated with the onset of diabetes, and the relationship is nonlinear. While it demonstrates limited discriminatory performance as a standalone screening tool, it remains suitable for initial risk stratification in primary health care institutions with limited resources.

Rethinking emergency risk assessment: A single-center look at shock index and its variants in COVID-19

by Annyi Tatiana Belalcazar, Valeria Monroy Lasso, José Darío Álvarez Herazo, Ana Clarete, Roger Figueroa-Paz, Duban Maya-Portillo, Julio Diez-Sepúlveda

Background

The Shock Index (SI) is a validated prognostic tool in conditions such as severe trauma and obstetric hemorrhage. During the COVID-19 pandemic, it was used to identify patients at higher risk of clinical deterioration, but results have been inconsistent. This study aimed to evaluate the prognostic value of the SI and its variants in predicting mortality, need for mechanical ventilation, and hospital length of stay in patients with moderate COVID-19.

Methods and findings

This longitudinal analytical observational study was conducted at a high-complexity hospital in southwestern Colombia and included adults over 18 years of age with moderate COVID-19 treated between 2020 and 2022, using data from the institutional RECOVID registry. A total of 283 patients were analyzed (median age: 61 years; 58.7% male), with cardiovascular and renal comorbidities being predominant. On admission, vital signs were stable (NEWS2: 3.0; shock index: 0.7). ICU admission was required in 29.3% of cases, and overall mortality was 12%. ROC curves and diagnostic accuracy parameters were used to assess the discriminatory ability of the SI and its variants. Most SI variants showed low discriminatory power (AUC  Conclusions

Early identification of patients at risk for complications in moderate COVID-19 is essential for optimizing hospital resources. The shock index and its variants showed limited utility as standalone predictors for mortality, ICU admission, and hospital length of stay. Combining SI with other clinical parameters may offer some benefit, but heterogeneity limits generalizability. Future studies should develop and prospectively validate multivariable models integrating clinical, laboratory, and imaging biomarkers.

Association between mink coronavirus (MCoV), <i>Campylobacter</i> spp., and diarrhea in farmed mink <i>(Neogale vison)</i>

by Michelle Lauge Quaade, Mikael Leijon, Mikhayil Hakhverdyan, Thomas Bruun Rasmussen, Charlotte Kristiane Hjulsager, Lars Andresen, Karin Mundbjerg, Anne Sofie Vedsted Hammer

Diarrhea outbreaks significantly affect the health and growth of farmed mink, posing economic and welfare challenges. While various pathogens have been linked to mink diarrhea, the causes during the weaning period remain unclear. Sporadic associations of mink coronavirus (MCoV), Campylobacter, and gastrointestinal disease in mink have been suggested. This study investigates the occurrence and levels of MCoV and Campylobacter in fecal samples from Danish farm mink (Neogale vison) and their potential association with post-weaning anorexia diarrhea syndrome (PADS), growth-period diarrhea (GPD), or pre-weaning diarrhea (PWD). The focus of the study is on PADS, studied through two case-control setups where case farms had known problems with PADS and control farms without such problems. Animals were also diagnosed based on necropsy pathological findings. Seventeen MCoV genomes were determined from five Danish farms. This data facilitated the development of an MCoV RT-qPCR and was applied across three study groups. Results showed high prevalence of both MCoV and Campylobacter spp. in all groups. No link was found between MCoV presence or levels and PADS diagnosis on the individual level; however, farm-level analysis revealed that MCoV was 2.35 times more likely (95% CI 1.027; 5.056) on PADS case farms than controls. Mink with PWD exhibited higher MCoV levels compared to GPD cases, suggesting a role at this developmental stage. Phylogenetic analysis revealed diverse and farm-specific MCoV strains, with sequences from healthy controls forming a distinct subclade, hinting at strain-specific pathogenicity. Campylobacter spp. presence was not significantly associated with PADS, but higher levels were observed in mink with PADS versus those without (not tested for PWD). These findings highlight the importance of surveillance and rigorous hygiene practices on mink farms to address risks from MCoV and Campylobacter spp., calling for further research to clarify their roles in PADS and overall mink health.

Correlation between self-regulatory fatigue and physical activity in lung cancer patients undergoing comprehensive treatment

by Qiaoling Li, Jing Zhang, Shasha Meng, Fengxiang Tian, Qinqin Mei, Hui Wang, Hong Qi

Background

Self-regulated fatigue is often assessed in studies of chronic diseases. Research is needed on the self-regulation of fatigue and physical activity in lung cancer patients undergoing treatment, and the impact of these factors on this population.

Objective

The goal of this study is to investigate the current status, influencing factors, and correlation between self-regulatory fatigue and physical activity in lung cancer patients undergoing comprehensive treatment.

Methods

We used a convenience sampling method to enroll 188 lung cancer patients admitted to two tertiary hospitals in Chengdu from October 2024 to April 2025. Data were collected using a general information questionnaire and two scales: the Self-Regulatory Fatigue Scale (SRF-S) and The International Physical Activity Questionnaire-long form (IPAQ-L).

Results

The mean self-regulatory fatigue score was 42.19 ± 9.06. The total metabolic equivalent (MET) of physical activity was 544.00 (0.00, 1386.00) MET-min/week, with leisure-time activity accounting for 429.00 (0.00, 1188.00) MET-min/week (data presented as median and interquartile range). Significant negative correlations were observed between Self-Regulatory Fatigue total scores and energy expenditure from housework, leisure activities, as well as total physical activity expenditure. Furthermore, self-regulatory fatigue was negatively correlated with both moderate-intensity and low-intensity physical activity, but positively correlated with high-intensity physical activity (P P R² = 0.306).

Conclusion

Engaging in appropriate leisure and household activities at moderate-to-low intensity may help alleviate the severity of self-regulatory fatigue in lung cancer patients undergoing comprehensive treatment. Healthcare providers should encourage appropriate activity to reduce the psychological burden and conserve self-regulatory resources.

Health and lifestyle in the Iron Age Italian community of Pontecagnano (Campania, Italy, 7th-6th century BCE)

by Roberto Germano, Owen Alexander Higgins, Emanuela Cristiani, Alessia Galbusera, Carmen Esposito, Dulce Neves, Carmine Pellegrino, Alessandra Sperduti, Giorgio Manzi, Luca Bondioli, Alessia Nava

This study investigates health, dental development, diet, and human-environment interactions in individuals buried in the necropolises of Pontecagnano (Campania, Italy, 7th-6th century BCE), using an integrated approach merging dental histomorphometry and calculus micro-residue analysis. The sample consists of 30 permanent teeth (canines, first and second molars) from 10 individuals. Histomorphometric analysis of dental thin sections allowed the estimation of crown formation times, initial cusp formation, crown completion, and enamel extension rates. The prevalence of Accentuated Lines, marking physiological stress events, was analyzed chronologically across tooth classes. Dental calculus analysis was performed on five individuals, identifying plant micro-remains and fungal spores. Crown formation times varied by tooth class, with canines forming the longest (mean = 1,977 ± 295 days), followed by second molars (mean = 1,176 ± 179 days) and first molars (mean = 1,094 ± 154 days). Initial cusp formation values, estimated through chronological overlap between teeth, allowed for a more accurate reconstruction of crown completion timing. Accentuated Lines prevalence peaked at 12 and 44 months, likely reflecting early childhood dietary transitions and the differential recording of stress events across different crown regions. Calculus analysis identified starch granules from cereals (Triticeae) and legumes (Fabaceae), fungal spores (Saccharomyces), and plant fibers, indicating diverse dietary practices, food processing, and extra-masticatory activities. This interdisciplinary approach reinforces the validity of combining histomorphometric and micro-residue analyses to reconstruct childhood health, adult diet, and lifestyle. Our findings align with previous research while emphasizing population-specific variations. This study enhances understanding of Iron Age biocultural adaptations, offering insights into developmental and dietary behaviors in this ancient Italian community.

Household factors influencing cockroach infestations and helminth parasites: Insights from a rural community in Guatemala

by Wendy C. Hernández-Mazariegos, Felipe I. Torres, Manuel Rodríguez, Christian M. Ibáñez, Luis E. Escobar, Federico J. Villatoro

Cockroaches are vectors of pathogens and parasites that pose public health risks, especially in developing countries with poor hygiene and inadequate infrastructure. This study aimed to identify the household factors associated with the occurrence of cockroaches and the helminth parasites they carry in a rural community. Data on household infrastructure, presence of domestic animals, and insect control methods were collected from 70 households in rural Guatemala. Cockroaches were captured using traps and manually. A Generalized Linear Mixed Model revealed that households with concrete roofs had 94% lower abundance of cockroaches than those with metal sheet roofs, while the presence of cats increased cockroach abundance by 2.6 times (p Moniliformis moniliformis, were identified, marking the first report of such parasites in household cockroaches in Guatemala. These results highlight the need for improved housing infrastructure and integrated pest management strategies to mitigate the risks associated with cockroach-borne parasites in vulnerable communities.

Clinical and social determinants of cardiovascular risk in a population with chronic noncommunicable diseases in Maicao, La Guajira, Colombia: 2024

by Paula Tatiana Angarita-Melo, Karen Panche-Castellanos, Víctor Zein Rizo-Tello, Ana Yibby Forero-Torres, Alexandra Porras-Ramírez

Aim

To determine the independent association and quantify the magnitude of influence of clinical and social determinants on the ten-year cardiovascular disease risk (estimated using the Framingham scale) in individuals diagnosed with arterial hypertension or type 2 diabetes mellitus in Maicao, La Guajira.

Methods

A cross-sectional analytical study was conducted among 273 adults enrolled in noncommunicable disease programs. Anthropometric, biochemical, and sociodemographic data were collected using standardized instruments. Multivariable logistic regression was used to identify and quantify factors associated with high cardiovascular disease risk (defined as 10% or greater Framingham score).

Results

The prevalence of high ten-year cardiovascular disease risk was 16.9%, being significantly higher in women (23.5%) compared to men (3.3%). The multivariable analysis quantified the influence of the determinants. Key clinical factors associated with the highest magnitude of risk were Type 2 Diabetes Mellitus (Adjusted Odds Ratio: 21.87) and High Blood Pressure (Adjusted Odds Ratio: 16.04). The independent effect of a social determinant, receiving a monthly salary, was also strongly associated with high risk (Adjusted Odds Ratio: 4.62). Conversely, being male and having normal High Density Lipoprotein cholesterol levels were identified as protective factors.

Conclusion

This study quantifies that, in addition to the strong influence of traditional clinical factors (T2DM and HBP), social determinants such as income-related work status exert a significant and independent effect on cardiovascular risk in this vulnerable population. The findings underscore the critical need for integrated public health strategies in Maicao, La Guajira, that not only target metabolic control but also effectively address structural social and gender inequalities to achieve a meaningful reduction in the cardiovascular disease burden.

Predicting the frequency of positive laboratory submissions for porcine reproductive and respiratory syndrome in Ontario, Canada, using autoregressive integrated moving average, exponential smoothing, random forest, and recurrent neural network

by Tatiana Petukhova, Maria Spinato, Tanya Rossi, Michele T. Guerin, Cathy A. Bauman, Pauline Nelson-Smikle, Davor Ojkic, Zvonimir Poljak

Porcine Reproductive and Respiratory Syndrome Virus (PRRSV) is endemic in many pig-producing countries and poses significant health and economic challenges. Enhanced surveillance strategies are essential for effective disease management. This study aimed to evaluate and compare the performance of different time-series modeling techniques to predict weekly PRRSV-positive laboratory submissions in Ontario, Canada. Ten years of PRRSV diagnostic data were obtained from the Animal Health Laboratory at the University of Guelph and were processed into a weekly time series. The dataset was analyzed with autoregressive integrated moving average (ARIMA), exponential smoothing (ETS), random forest (RF), and recurrent neural network (RNN) models. Two validation strategies were employed: a traditional train-test split and a simulated prospective rolling forecast. Model accuracy was evaluated using common predictive error metrics. Descriptive analysis indicated a gradual increase in PRRSV positive submissions over time, with no consistent seasonal pattern. ARIMA and ETS models generally overpredict case counts, while RF and RNN tended to underpredict them. Among the evaluated models, the RF regression model most accurately captured the underlying time-series dynamics and produced the lowest prediction errors across both validation approaches. Despite outperforming other models, the RF model’s high relative prediction errors limit its suitability for accurate forecasting of PRRSV-positive submissions in Ontario’s routine surveillance system. Further data refinement and algorithm improvements are warranted.

Understanding the mechanisms of infodemics: Equation-based vs. agent-based models

by Cristian Berceanu, Francesco Bertolotti, Nadia Arshad, Monica Patrascu

In an era where digital communication accelerates the global spread of false narratives, understanding how misinformation and disinformation propagate, especially during crises such as the COVID-19 pandemic, is vital to public health and policy. To delve into the diffusion mechanisms of misinformation (unintentionally false information) and disinformation (intentionally false information), we introduce a novel enhanced agent-based model (ABM) that integrates psycho-social factors and communication networks, which are elements often overlooked in traditional equation-based models (EBMs). We assess the two distinct techniques (ABMs and EBMs) through the lens of six classical SEIRS-class models (S susceptible, E exposed, I infected, R recovered). Beside the enhanced ABM, we also develop a simple ABM to emulate the EBM structure. We compare the ABMs with the EBMs over their entire parameter ranges in a total of 11110 experiments. Results show an overall weak equivalence between the two types of models, even if, under certain conditions, the outcomes of the EBMs and ABMs are similar. Furthermore, we evaluate the two model types by fitting them to real-world infodemic data on vaccine acceptance over 36 weeks using a multi-objective optimization procedure. The enhanced ABM shows an exceptionally better fit to real-world data (Pearson’s correlation coefficient ρ = 0.872 and normalized root mean of square error NRMSE  = 0.055) than the EBM (ρ=−0.067, NRMSE  = 0.418) and the simple ABM (ρ=0.391, NRMSE  = 0.103). These findings underscore the critical role of model structure in capturing infodemic dynamics, and advocate for the use of ABMs when psycho-social influences and network interactions are central to the phenomenon.

Cyclodextrin reduces cholesterol crystal uptake by circulating monocytes in patients undergoing coronary angiography

by Nikola Lübbering, Alexander Krogmann, Felix Jansen, Eicke Latz, Georg Nickenig, Sebastian Zimmer

Background

Atherosclerosis is a chronic inflammatory disease driven by endothelial dysfunction, cholesterol accumulation, and immune activation leading to thrombosis and vascular stenosis. While LDL-lowering therapies are firmly established, targeting the underlying inflammation is still an emerging strategy. Cholesterol crystals (CC) contribute to inflammation by activating the NLRP3 inflammasome in monocytes and promoting disease progression. Cyclodextrin (CD), an FDA-approved drug carrier, has shown atheroprotective effects by enhancing cholesterol metabolism and reducing inflammation in preclinical models. This study investigated whether CC-uptake in human monocytes, a prerequisite for inflammasome activation, is also influenced by CD pretreatment.

Methods

Human peripheral mononuclear cells were isolated from whole blood samples provided by 76 patients undergoing coronary angiography at the University Hospital Bonn between November 2017 and February 2018. After separation, peripheral mononuclear cells were stimulated with 2-Hydroxypropyl-γ-Cyclodextrin and CC. CC-uptake by monocytes was analyzed using flow cytometry.

Results

CC-uptake by monocytes varied greatly between patients (8–37%), with lower uptake observed in patients with elevated leukocytes (p = 0.0058) and diabetes mellitus (p = 0.0448). CD-pretreatment significantly reduced CC-uptake (20.1% ± 0.8% vs. 15.0% ± 0.6%, p p = 0.0316), requirement for percutaneous coronary intervention (PCI) (p = 0.0030), and elevated leucocyte levels (p = 0.0135) had lower CCΔCD, suggesting a link between systemic inflammation and attenuated CD efficacy.

Conclusion

We demonstrated that CD significantly reduced CC-uptake in patients undergoing coronary angiography, which supports its role in inhibiting CC-phagocytosis and promoting cholesterol efflux. Interestingly, patient response to CD varied, with those exhibiting greater systemic inflammation or CAD showing a less pronounced reduction in CC-uptake. Our findings provide insight into the atheroprotective mechanisms of CD and suggest its potential utility in evaluating individual cardiovascular risk and monitoring CD-based therapeutic interventions in humans.

Study on the release pattern of Zn in soil of ionic rare earth mining areas under different leaching conditions

by Zhongqun Guo, Qiangqiang Liu, Feiyue Luo, Shaojun Xie, Tianhua Zhou

The acidic leachate injected during the mining process of ion-type rare earth ores can damage the environmental characteristics of the soil, thereby triggering the activation and release of associated heavy metals. Severe Zn contamination has been found in the environment of ion-type rare earth mining areas, but the activation and release of Zn in the soil during the leaching process have not been fully understood. This study investigated the activation and release patterns and mechanisms of Zn in soil under different leaching agents ((NH4)2SO4, MgSO4, Al2(SO4)3) and varying concentrations of Al2(SO4)3 (1%, 3%, 5%, 7%) using a simulated leaching experimental system. The results show that the activation and release patterns of Zn in the soil vary significantly under the influence of the three leaching agents. During the entire leaching cycle, the peak Zn concentration in the leachate was highest under MgSO4 leaching, while the residual Zn content in the soil under Al2(SO4)3 leaching approached the high-risk environmental threshold. The high-concentration systems (5%, 7%) of Al2(SO4)3 significantly enhanced the activation and release efficiency of Zn in the soil compared to the low-concentration systems (1%, 3%) of Al2(SO4)3. (NH4)2SO4 mainly promotes the activation and release of Zn through ion exchange between NH4+ and Zn2+ and the acidification effect; Al2(SO4)3, on the other hand, dominates the activation and release of Zn by providing a strongly acidic environment and dissolving and damaging the mineral lattice; while MgSO4 not only exchanges ions between Mg2+ and Zn2+, but also alters the soil colloidal structure, facilitating Zn activation and release. The promoting effects of the three leaching agents on the transformation of Zn in soil follow the order of Al2(SO4)3> (NH4)2SO4 > MgSO4, with the environmental risk assessment index (RAC) being highest after Al2(SO4)3 leaching, indicating the greatest potential environmental risk. Compared to the other three concentrations (1%, 5%, 7%) of Al₂(SO4)3, the 3% concentration of Al2(SO4)3 had the most significant promoting effect on the transformation of Zn in soil. This study provides a theoretical basis for optimizing the green mining process of ion-type rare earth ores and preventing heavy metal pollution, and offers scientific support for revealing pollution mechanisms and formulating remediation and risk assessment strategies.

A multi-image codebook approach for secure text transmission

by Omar Fitian Rashid, Saba A. Tuama, Humam Al-Shahwani

In modern digital communication, Confidentiality of text transmission is remains a concern in the current online communication as cyber threats and intrusion. To address these challenges, this paper proposes a dual-layered security system that integrates cryptography and multi-image steganography to strengthen text protection during transmission. The cryptography layer is done based eight steps; in the first one, the message is converted to ASCII format, then convert the ASCII values into their equivalent binary numbers and make a complement to the binary values where each 0’s becomes 1’s and vice versa. In the next step, it needs to enter a key that includes a combination of characters, numbers, and special characters. This key is also converted to binary, and then the XOR operation is made between the message of the binary values and the key. In the fifth step, switching the values of each two adjacent binary values are together and converted to decimal values. While the second layer embeds the ciphertext in several cover images using a randomized codebook along with the Least Significant Bit (LSB) substitution, thus enhancing undetectability. Experimental evaluation demonstrates fast execution times for both the encryption/decryption processes and the multi-image hiding/extraction procedures. The achieved results validate that the proposed system provides an efficient and highly secure framework for protecting sensitive information.

Generational mutation patterns in a honey bee Deformed wing virus via infectious clones

by Anthony Nearman, Alriana Buller-Jarrett, Dawn Boncristiani, Eugene Ryabov, Yanping Chen, Jay D. Evans

Efforts to improve honey bee colony health continue due to persistent high loss rates. A major focus in this area is Deformed wing virus (DWV), a key driver of colony loss. The application of modern molecular techniques has characterized the DWV genome and its high mutational rate that enables the formation of diverse quasi-species populations capable of evading host immune responses, while other work has led to the development of DWV clones suitable for sequence-specific tracking of viral dynamics. In this work we combine knowledge of these efforts to track the mutational progression in a DWV clone surrounding an area of low nucleotide diversity and compare it to its wild-type source. We achieve this through amplicon sequencing of the structural viral protein, VP2, after incubation across three generations and multiple host genetic sources. Inocula were injected into pupae, allowed to replicate, then extracted for a further two generations of injections. For the final injection generation, recipient pupae were injected with preparations from either the same genetic source or cross-fostered from other colonies. Overall, we compared the mean number and type of mutations, their proportional abundance in the read pool, and specific locations across strains. Sequencing results indicate a limited number of mutational hotspots, which were driven by silent mutations in the final injection generation of the wild-type strains. No significant differences were found among other mutation types, cross-fostering status, or interactions with host genetics. This work is an initial attempt at examining viral dynamics in a cloned system across multiple generations and treatment groups. The results provide valuable insights, which may further enhance our understanding of viral dynamics and potentially improve future honey bee therapeutics.

Design, 3D printing, and preclinical validation of an extraglottic ramp to facilitate blind orotracheal intubation in emergency airway management

by Jorman H. Tejada-Perdomo, Valentina Gutierrez-Perdomo, Juana V. Agudelo-Castro, Jorge A. Pérez-Gamboa, Alejandro Weinstein, Sebastián San Martín, Rodrigo Salas, Jorge A. Ramos-Castaneda

The use of devices that facilitate rapid airway isolation is essential when managing critical patients in emergencies. In recent years, additive manufacturing has emerged as an innovative, versatile, and accessible technology for developing medical devices. This study presents the design, development, and validation of an extraglottic medical device created using computer-aided design tools and stereolithographic 3D printing to facilitate blind intubation by first responders. The device was iteratively modeled and fabricated with biocompatible materials; validation in airway simulators and human cadaveric specimens assessed dimensions, friction, intubation technique, and learning curve, and ease of use was rated with a Likert scale. Ten iterations led to a final design with low friction and minimal cervical manipulation; ramp angle, cup geometry, and distal tip were optimized for tube passage, and BioMed Flex 80A showed high strength and anatomical compatibility. The final version is a safe, reusable, and functional alternative for airway management and blind orotracheal intubation, particularly in emergencies and resource-limited settings; clinical validation in live patients is still needed.
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